Skip to main navigation Skip to main content

CEEM : Clinical and Experimental Emergency Medicine

OPEN ACCESS
Search
Advanced Search
ABOUT
BROWSE ARTICLES
FOR CONTRIBUTORS

Articles

Page Path

Editorial
Critical Care

Epidemiology of sepsis in emergency departments: insights from the National Emergency Department Information System (NEDIS) database in Korea, 2018–2022

Tae Gun Shin1orcid, Eunsil Ko2orcid, So-hyun Han2orcid, Taehui Kim2, Dai Hai Choi2orcid
Clinical and Experimental Emergency Medicine 2025;12(3):185-187.
Published online: September 30, 2025

1Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

2National Emergency Medical Center, National Medical Center, Seoul, Korea

Correspondence to: Tae Gun Shin Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Email: drshin88@gmail.com
Co-correspondence to: Dai Hai Choi National Emergency Medical Center, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul 04564, Korea Email: emergency@nmc.or.kr
• Received: August 4, 2025   • Accepted: August 9, 2025

© 2025 The Korean Society of Emergency Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).

  • 3,473 Views
  • 50 Download
  • 4 Web of Science
  • 7 Crossref
  • 3 Scopus
next

Full Article

Download PDF Download PDF
Sepsis is a life-threatening organ dysfunction caused by a dysregulated response to infection, it represents a leading cause of mortality and worldwide [1,2]. Recent estimates suggest that roughly 30 million to 50 million cases and 6 million to 11 million deaths worldwide are due to sepsis each year [3-5]. However, the true burden of sepsis is difficult to quantify precisely, and reported incidence and mortality rates may vary widely by country, healthcare setting, and surveillance methodology [4,6].
In Korea, the National Emergency Department Information System (NEDIS) collects clinical and administrative information from approximately 400 emergency medical centers nationwide. Each year it reports national trends for 28 severe illness diagnosis codes including sepsis, but these counts are based on a narrow set of explicit codes in the Korean Classification of Diseases (KCD), and episodes labeled improperly may be missed [7].
In this study, we analyzed diagnosis codes from the NEDIS database from 2018 to 2022. Three hierarchical case definitions were applied: (1) explicit sepsis codes representing a primary or secondary KCD-8 diagnosis of sepsis or septic shock; (2) severe infection proxy denoted with any infection code [8] and either admission directly from the emergency department (ED) to an intensive care unit (ICU) or death in the ED; and (3) combination of (1) and (2). Because NEDIS does not include laboratory results or claims for specific organ-support therapies, ICU admission and ED death were used as pragmatic proxies for critical illness.
Of the 40,079,939 total patient encounters in the NEDIS database, 10,661,901 individuals (26.6%) were identified with an infection-related diagnosis, showing a mortality rate of 2.3%. Among this cohort, a smaller group of 254,690 patients (6.4 cases per 1,000 ED visits) had an explicit diagnosis code for either sepsis or septic shock (Table 1). Using a proxy definition for severe infection—any infection diagnosis combined with ICU admission or death—the encounter rate was 12.0 cases per 1,000 ED visits with a mortality of 23.8%. When this proxy was combined with sepsis and septic shock diagnosis codes for the most inclusive estimate, the rate increased to 15.4 cases per 1,000 ED visits, with an overall mortality rate of 22.8%. In the adult population (≥18 years), this comprehensive definition identified 582,244 patients, with a mortality rate of 24.1% and an encounter rate of 18.2 per 1,000 adult ED visits. In contrast, the pediatric population (<18 years) accounted for 34,448 patients, with a mortality rate of 2.1% and an encounter rate of 4.7 per 1,000 pediatric ED visits. Although this approach captures more suspected sepsis cases, it misses patients admitted to general wards without ICU care or those transferred to another hospital; applying a broader case definition with richer clinical data would likely reveal a substantially larger sepsis population.
The ED is the frontline of sepsis care, receiving 50% to 70% of all hospitalized sepsis cases [8,9]. Yet most Korean ED data are collected from university hospital–based registries or administrative reports that count only encounters carrying explicit sepsis diagnosis codes [10-12]. Consequently, the burden of sepsis, timeliness of care, and outcomes in regional and community hospitals remain largely unknown. A more comprehensive, population-wide surveillance system, either by augmenting NEDIS or by establishing a dedicated national registry, will be essential for capturing the true epidemiological burden of sepsis across all healthcare settings and for developing effective, data-driven strategies to improve patient outcomes.

Ethics statement

This study was approved by the Institutional Review Board of the National Emergency Medical Center of Korea (No. NMC-2023-08-094). The requirement for informed consent was waived due to the retrospective, observational, and anonymous nature of the study.

Author contributions

Conceptualization: TGS; Formal analysis: all authors; Investigation: all authors; Supervision: TGS, DHC; Writing–original draft: TGS; Writing–review & editing: all authors. All authors read and approved the final manuscript.

Conflicts of interest

Tae Gun Shin is an editorial board member of this journal, but was not involved in the peer reviewer selection, evaluation, or decision process for this article. The authors have no other conflicts of interest to declare.

Funding

This study was supported in part by a grant from the Patient-Centered Clinical Research Coordinating Center (PACEN), funded by the Korean Ministry of Health and Welfare (No. RS-2024-00398566), awarded to Tae Gun Shin. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Acknowledgments

The authors thank Doyeop Kim for their assistance with data processing and analysis.

Data availability

Data analyzed in this study were obtained from the National Emergency Medical Center (NEMC), under the Korean Ministry of Health and Welfare. The data are not publicly accessible because they were used under license for this study (No. N2023-07-0-09-09). However, they are available from the corresponding author upon reasonable request, with permission from the NEMC.

Table 1.
Comparative estimates of sepsis epidemiology based on the NEDIS database in Korea (2018–2022), by case definition
Table 1.
Sepsis estimation No. of patients Hospital mortality rate (%) No. of patients per 1,000 ED visits
Sepsis diagnosis codea) 197,197 24.0 4.9
Septic shock diagnosis codeb) 100,969 38.4 2.5
Sepsis and septic shock diagnosis codea),b) 254,690 26.6 6.4
Infection diagnosis codec) AND ICU admission/ED death 481,894 23.8 12.0
(Infection diagnosis codec) AND ICU admission/ED death) OR sepsis/septic shock diagnosis codea),b) 616,692 22.8 15.4
Adult patients only (≥18 yr) 582,244 24.1 18.2d)
Pediatric patients only (<18 yr) 34,448 2.1 4.7d)

ED, emergency department; ICU, intensive care unit.

Diagnosis codes from the Korean Standard Classification of Diseases, 8th Revision (KCD-8):

a)A021, A227, A241, A267, A400–A409, A410–A414, A419, A427, B007, B377;

b)R572.

c)Infection diagnosis codes were modified from a previous epidemiologic study [8]. Common viral infection codes including influenza and COVID-19 were included.

d)Per 1,000 age-specific ED visits.

  • 1. Prescott HC, Harrison DA, Rowan KM, Shankar-Hari M, Wunsch H. Temporal trends in mortality of critically ill patients with sepsis in the United Kingdom, 1988-2019. Am J Respir Crit Care Med 2024;209:507-16.
  • 2. Singer M, Deutschman CS, Seymour CW, et al. The third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315:801-10.
  • 3. Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet 2020;395:200-11.
  • 4. Reinhart K, Daniels R, Kissoon N, et al. Recognizing sepsis as a global health priority: a WHO resolution. N Engl J Med 2017;377:414-7.
  • 5. Fleischmann C, Scherag A, Adhikari NK, et al. Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations. Am J Respir Crit Care Med 2016;193:259-72.
  • 6. Kumar A, Venkatesh B, Finfer S, et al. Accuracy of the modified Global Burden of Disease International Classification of Diseases coding methods for identifying sepsis: a prospective multicentre cohort study. Crit Care 2025;29:218.
  • 7. Yoo HH, Ro YS, Ko E, et al. Epidemiologic trends of patients who visited nationwide emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018-2022. Clin Exp Emerg Med 2023;10:S1-12.
  • 8. Kim J, Kim K, Lee H, Ahn S. Epidemiology of sepsis in Korea: a population-based study of incidence, mortality, cost and risk factors for death in sepsis. Clin Exp Emerg Med 2019;6:49-63.
  • 9. Wang HE, Shapiro NI, Angus DC, Yealy DM. National estimates of severe sepsis in United States emergency departments. Crit Care Med 2007;35:1928-36.
  • 10. Namgung M, Ahn C, Park Y, et al. Mortality among adult patients with sepsis and septic shock in Korea: a systematic review and meta-analysis. Clin Exp Emerg Med 2023;10:157-71.
  • 11. You JS, Park YS, Chung SP, et al. Relationship between time of emergency department admission and adherence to the surviving sepsis campaign bundle in patients with septic shock. Crit Care 2022;26:43.
  • 12. Hong G, Ju H, Oh DK, et al. Clinical characteristics and prognostic factors of sepsis in patients with malignancy. Sci Rep 2025;15:7078.

Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

Format:

Include:

Epidemiology of sepsis in emergency departments: insights from the National Emergency Department Information System (NEDIS) database in Korea, 2018–2022
Clin Exp Emerg Med. 2025;12(3):185-187.   Published online September 30, 2025
DOI: https://doi.org/10.15441/ceem.25.174
Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.
Format:
Include:
Epidemiology of sepsis in emergency departments: insights from the National Emergency Department Information System (NEDIS) database in Korea, 2018–2022
Clin Exp Emerg Med. 2025;12(3):185-187.   Published online September 30, 2025
DOI: https://doi.org/10.15441/ceem.25.174
Close

Related topics

Epidemiology of sepsis in emergency departments: insights from the National Emergency Department Information System (NEDIS) database in Korea, 2018–2022
Epidemiology of sepsis in emergency departments: insights from the National Emergency Department Information System (NEDIS) database in Korea, 2018–2022
Sepsis estimation No. of patients Hospital mortality rate (%) No. of patients per 1,000 ED visits
Sepsis diagnosis codea) 197,197 24.0 4.9
Septic shock diagnosis codeb) 100,969 38.4 2.5
Sepsis and septic shock diagnosis codea),b) 254,690 26.6 6.4
Infection diagnosis codec) AND ICU admission/ED death 481,894 23.8 12.0
(Infection diagnosis codec) AND ICU admission/ED death) OR sepsis/septic shock diagnosis codea),b) 616,692 22.8 15.4
Adult patients only (≥18 yr) 582,244 24.1 18.2d)
Pediatric patients only (<18 yr) 34,448 2.1 4.7d)
Table 1. Comparative estimates of sepsis epidemiology based on the NEDIS database in Korea (2018–2022), by case definition

ED, emergency department; ICU, intensive care unit.

Diagnosis codes from the Korean Standard Classification of Diseases, 8th Revision (KCD-8):

A021, A227, A241, A267, A400–A409, A410–A414, A419, A427, B007, B377;

R572.

Infection diagnosis codes were modified from a previous epidemiologic study [8]. Common viral infection codes including influenza and COVID-19 were included.

Per 1,000 age-specific ED visits.

Table 1.

CEEM : Clinical and Experimental Emergency Medicine

ABOUT

BROWSE ARTICLES

FOR CONTRIBUTORS

© The Korean Society of Emergency Medicine.